Grave's disease and ruptured benign cystic struma ovarii (Grave's diasease and struma ovarii).
- Author:
Cherrie Mae C SISON
;
Frances Lina C LANTION-ANG
- Publication Type:Feature Article
- MeSH:
Human;
Female;
Adult;
Grave's Disease;
Struma Ovarii
- From:
Philippine Journal of Internal Medicine
2008;46(1):45-50
- CountryPhilippines
-
Abstract:
CLINICAL PRESENTATION: A 38 year old Filipina had a 3 days of colicky epigastric pain, vomiting and high grade fever. She had salphingooophorectomy for a left ovarian cystic teratoma in 1995, and is on propylthiouracil (PTU) and propranolol for Grave's disease since December 2004. However, thyrotoxicosis persisted. On admission, the abdomen was rigid and tenderness. Pelvic examinatin showed posterior cul de sac tenderness. TSH was 0.007 mIU/L (NV 0.3 - 3.8 mIU/L) while FT4 was 30.5 pmol/L (NV 11 - 24 pmol/L). Transvaginal ultrasound revealed an abdominopelvic mass. Burch-Wartofsky score was 35. Prior to surgery, PTU as retention enema, IV iodinated contrast, dexamethasone, and paracetamol were given. Exploratory laparotomy revealed a ruptured right cystic ovary. Histopathologic diagnosis was struma ovarii. FT4 remained elevated (38.1 to 46 pmol/L) postoperatively. Scintigraphy showed an enlarged thyroid with elevated 2 and 24 hour uptake. RAI was given after a year.Significance: Cystic variant of struma ovarii is rare, but coexistence of Graves disease and struma ovarii is even more uncommon, with only 12 other cases reported. This case is complicated by ovarian cysy rupture, resulting in an acute abdomen in a patient with impending thyroid storm.CONCLUSIONS: A high index of suspicion is necessary for the diagnosis of struma ovarii, especially with coexistent Graves' disease. Diagnosis should be considered in patients who remain thyrotoxic despite adequate treatment and in those with pelvic masses and concomitant thyrotoxicosis. Surgery for the struma ovarii should be emphasized as part of adequate treatment.
